ASSESSMENT OF THE RELATIONSHIP BETWEEN MATERNAL WELLBEING...
Transcript of ASSESSMENT OF THE RELATIONSHIP BETWEEN MATERNAL WELLBEING...
ASSESSMENT OF THE RELATIONSHIP BETWEEN MATERNAL
WELLBEING AND FETAL OUTCOME AMONG POSTNATAL
MOTHERS AT SELECTED HOSPITALS IN CHENNAI.
Dissertation submitted to
THE TAMILNADU DR.M.G.R.MEDICAL UNIVERSITY
CHENNAI-600 032
In partial fulfillment of the requirement for the degree of
MASTER OF SCIENCE IN NURSING
OCTOBER-2017
ASSESSMENT OF THE RELATIONSHIP BETWEEN MATERNAL
WELLBEING AND FETAL OUTCOME AMONG POSTNATAL
MOTHERS AT SELECTED HOSPITALS IN CHENNAI.
SIGNATURE OF THE EXTERNAL EXAMINER
SIGNATURE OF THE INTERNAL EXAMINER
ASSESSMENT OF THE RELATIONSHIP BETWEEN MATERNAL
WELLBEING AND FETAL OUTCOME AMONG POSTNATAL
MOTHERS AT SELECTED HOSPITALS IN CHENNAI.
Certified that this is the bonafide work of
Ms. Divya.V
II Year M.Sc., Nursing
M.A.Chidambaram College of Nursing
V.H.S., T.T.T.I. Post, Adyar,
Chennai -600 113
Signature ---------------------------------- Prof. Dr. R. Sudha, R.N., R.M., M.Sc (N), Ph.D,
Principal and Professor in Nursing
M.A.Chidambaram College of Nursing
V.H.S., T.T.T.I. Post, Adyar, Chennai -600 113
Dissertation submitted to
THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY
CHENNAI – 600 032
In partial fulfillment of the requirement for the degree of
MASTER OF SCIENCE IN NURSING
OCTOBER – 2017
ASSESSMENT OF THE RELATIONSHIP BETWEEN MATERNAL
WELLBEING AND FETAL OUTCOME AMONG POSTNATAL
MOTHERS AT SELECTED HOSPITALS IN CHENNAI.
Approved by the Dissertation Committee in June-2016
PROFESSOR IN NURSING RESEARCH
Prof. Dr. R. SUDHA, R.N., R.M., M.Sc.(N), Ph.D
Principal and Professor in Nursing _______________ M.A. Chidambaram College of Nursing V.H.S., T.T.T.I. Post, Adyar, Chennai - 600 113.
CLINICAL SPECIALITY EXPERT
Mrs. ELIZEBETH RANI, R.N., R.M., M.Sc. (N). Reader in Nursing _______________
M.A.Chidambaram College of Nursing
V.H.S., T.T.T.I. Post, Adyar, Chennai - 600 113.
MEDICAL EXPERT
Dr. SUBBULAKSHMI, M.B.B.S., DGO. Chief Consultant ______________
Pankajam Memorial Hospital Hindu Colony, Nanganallor, Chennai-600 061.
Dissertation submitted to
THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY
CHENNAI – 600 032
In partial fulfillment of the requirement for the degree of
MASTER OF SCIENCE IN NURSING
OCTOBER – 2017
ACKNOWLEDGEMENT
I praise and thank “LORD ALMIGHTY” for showering his blessings to
complete the study successfully.
I express my sincere thanks and honour to the Managing Trustees,
M.A.Chidambaram College of Nursing for giving me this opportunity to pursue my post
graduate education in this esteemed institution.
I express my deep sense of gratitude and cordial thanks to Prof. Dr. R. Sudha,
R.N., R.M., M.Sc.(N)., Ph.D, Principal, M.A. Chidambaram College of Nursing for her
untiring intellectual guidance, concern, patience, kind support, enlightening ideas,
precious suggestions, constant supervision and willingness to help at all times for the
successful completion of the research work.
I extend my sincere gratitude and heartful thanks to Mrs. Prema Janardan,
R.N., R.M., M.Sc.(N), Vice Principal, M.A.Chidambaram College of Nursing for her
constructive suggestions, valuable support, concern, encouragement and guidance to
complete this study.
I extend my sincere gratitude and heartful thanks to Mrs.V.Elizebeth Rani,
R.N., R.M., M.Sc.(N), Reader in Nursing, M.A.Chidambaram College of Nursing for
her constructive suggestions, valuable support, concern, encouragement and guidance to
complete this study.
I extend my sincere thanks to Prof. Dr. Veena M. Joseph, R.N., R.M.,
M.Sc.(N)., Ph.D, Vice Principal, Chettinad College of Nursing, Kelambakkam,
Prof. Mrs. Safreena, R.N., R.M., M.Sc.(N)., Vice Principal, Mohamed Sathak A.J.
College of Nursing, Siruseri and Prof. Dr. Irin Praveen, R.N., R.M., M.Sc.(N)., Ph.D,
Vice Principal, Venkateshwara College of Nursing, Thalambur for validating the content
of the tool for this study.
I owe a profound debt of gratitude to Dr. Subbulakshmi, M.B.B.S., DGO.,
Chief Consultant, Pankajam Memorial Hospital, Chennai and Dr. Betty Chacko,
M.B.B.S., MD., Senior Consultant, Neonatologist, CSI Kalyani Multispeciality
Hospital, Chennai for validating the content of the tool and for their guidance.
I would like to express my gratitude to the Dr. J. JereneJayanth, M.D., DCH.,
Medical Director, CSI Kalyani General Hospital, Chennai and Managing Director,
Pankajam Memorial Hospital, Chennai for granting permission to conduct the study in
their esteemed institutions.
My immense thanks and gratitude to Dr. Elizabeth Sangeetha, Associate
Professor, Department of Statistics, Agni College of Engineering, Chennai for her
statistical assistance.
I am grateful to Ms. Sai Swathanthra Kumari, Librarian, M.A. Chidambaram
College of Nursing, for the co-operation and assistance.
I am at dearth of words to express my gratitude to my family members and
friends for their support and encouragement.
I owe a deep sense of gratitude to all my study participants who consented to
participate in this study.
TABLE OF CONTENTS
CHAPTER CONTENT PAGE NO.
I INTRODUCTION 1
Background of the Study 2
Need for the Study 5
Statement of the Problem 7
Objectives of the Study 7
Operational Definitions 7
Hypothesis 8
Assumptions 9
Delimitation 9
Projected Outcome 9
Conceptual Framework 9
II REVIEW OF LITERATURE 13
III METHODOLOGY 21
Research Approach 23
Research Design 23
Variables of the Study 23
Settings of the study 23
Population of the Study 23
Samples of the Study 23
Criteria for Selection of Sample 24
Inclusion Criteria 24
Exclusion Criteria 24
CHAPTER CONTENT PAGE NO.
Sampling size 24
Sampling Technique 24
Tool for data collection 25
Validity and Reliability of the Tool 27
Human rights and Ethical consideration 27
Pilot Study 27
Recommendations of the Pilot Study 28
Data Collection Method 28
Plan for Data Analysis 29
IV DATA ANALYSIS AND INTERPRETATION 30
V DISCUSSION 51
VI SUMMARY, CONCLUSION, IMPLICATIONS,
AND RECOMMENDATIONS
58
REFERENCES 64
APPENDICES
LIST OF TABLES
TABLE
NO. TITLE
PAGE
NO.
1.1 Frequency and percentage distribution of the postnatal
mothers based on demographic variables such as age in
years, educational status, occupation and type of work.
31
1.2 Frequency and percentage distribution of the postnatal
mothers based on demographic variables such as family
income per month, religion, residence, type of family and
personal habits.
32
2.1 Frequency and percentage distribution of the postnatal
mothers based on obstetrical variables such as gravida, para,
number of live children and abortion
33
2.2 Frequency and percentage distribution of the postnatal
mothers based on obstetrical variables such as type of
delivery, initiation of antenatal care, vaccination, iron and
folic acid intake, maternal weight gain and BMI at term.
34
3.1 Frequency and percentage distribution of maternal wellbeing
status among postnatal mothers.
35
3.2 Frequency and percentage distribution of the fetal outcome
among neonates.
36
4 Correlation of maternal wellbeing and fetal outcome among
postnatal mothers.
37
5.1 Association of maternal wellbeing with demographic
variables such as age, education, occupation andnature of
work among postnatal mothers.
39
5.2 Association of maternal wellbeing with demographic
variables such as family income per month, religion,
residence, type of family and personal habits among
postnatal mothers.
41
TABLE
NO. TITLE
PAGE
NO.
5.3 Association of fetal outcome with demographic variables
such as age, education, occupation and family income per
month among postnatal mothers.
42
5.4
Association of fetal outcome with demographic variables
such as religion, residence, type of family and personal habits
among postnatal mothers.
44
6.1 Association of maternal wellbeing with obstetrical variables
such as gravida, para, number of live children and abortion
among postnatal mothers.
45
6.2 Association of maternal wellbeing with obstetrical variables
such as type of delivery, initiation of antenatal care,
vaccination, iron and folic acid intake, maternal weight gain
and BMI among postnatal mothers.
46
6.3 Association of fetal outcome with obstetrical variables such
as gravida, para, number of live children and abortion among
postnatal mothers.
48
6.4 Association of fetal outcome with obstetrical variables such
as type of delivery, initiation of antenatal care, vaccination,
iron and folic acid intake, maternal weight gain and BMI
among postnatal mothers.
49
LIST OF FIGURES
FIGURE
NO. TITLE
PAGE NO.
1 Conceptual framework on Donabedian Health Care
outcome Model
12
2 Schematic representation on methodology 22
3 Correlation of percentage distribution on maternal
wellbeing and fetal outcome.
38
4 Percentage distribution of demographic variables such
as age, occupation and nature of work based on
maternal wellbeing.
40
5 Percentage distribution of demographic variables such
as age, occupation and income of the family based on
fetal outcome.
43
6 Percentage distribution of obstetric variables such as
gravida, abortion, type of delivery, iron and folic acid
intake, maternal weight gain and BMI based on
maternal wellbeing.
47
7 Percentage distribution of obstetric variables such as
type of delivery and iron and folic acid intake based on
fetal outcome.
50
LIST OF APPENDICES
APPENDIX NO. TITLE
I Letter seeking permission for conducting the study
II Certificate for content validity
III Informed consent form
IV Data collection tool (English)
V Certificate for English and Editing
STUDY TO ASSESS THE RELATIONSHIP BETWEEN
MATERNAL WELLBEING AND FETAL OUTCOME AMONG
POSTNATAL MOTHERS.
ABSTRACT
INTRODUCTION
Woman is the glory of creation. Pregnancy and childbirth are special events in
women’s lives and indeed the lives of their families. Good maternal health is crucial for
a healthy birth outcome for both mother and the fetus. Staying healthy while pregnant is
not only for mother’s physical and mental wellbeing, but also for the growing baby. The
investigator from her clinical experience noticed that the pregnant mother with the poor
weight gaining pattern, low haemoglobin level, PIH, GDM had a child birth with poor
fetal outcome like preterm birth, IUGR and low birth weight baby. At the same time, few
pregnant mother had the same risk factors, but delivered a healthy baby. So, the
investigator interested to identify the relationship between the maternal wellbeing and
fetal outcome among postnatal mother.
STATEMENT OF THE PROBLEM
A study to assess the relationship between maternal wellbeing and fetal outcome
among postnatal mothers at selected hospitals in Chennai.
OBJECTIVES OF THE STUDY
• To assess the maternal wellbeing and fetal outcome.
• To correlate the maternal wellbeing and fetal outcome.
• To associate the maternal wellbeing and fetal outcome with the demographic
variables like the age, education, occupation and socio economic status.
• To associate the maternal wellbeing and fetal outcome with the obstetrical
variables like gravida, para, number of live children, abortion, type of delivery,
initiation of antenatal care, vaccination and iron and folic acid intake.
HYPOTHESIS
H01- There is no relationship between maternal wellbeing and fetal outcome.
H02- There is no association between maternal wellbeing and demographic variables
like maternal age, education and socioeconomic status.
H03- There is no association between maternal wellbeing with obstetrical variables like
gravida, para, number of live children, abortion, type of delivery, iron and folic
acid intake and maternal weight gain.
H04- There is no association between fetal outcomes with demographic variable like
maternal age, education and socioeconomic status.
H05- There is no association between fetal outcomes with obstetrical variables like
gravida, para, number of live children, abortion, type of delivery, iron and folic
acid intake and maternal weight gain.
METHODOLOGY
The descriptive design was used as research design. The setting of the study was
CSI Kalyani Multispecialty Hospital, Mylapore, Chennai and Pankajam Memorial
Hospital, Nanganallor, Chennai. Total 120 samples were selected using non probability
convenient sampling technique.
MEASUREMENT AND TOOL
Data were obtained from the postnatal mothers by self- report regarding the
demographic and obstetrical data; review of antenatal records and mothers response
regarding maternal wellbeing and fetal outcome using antenatal and newborn data. The
data was analyzed using descriptive and inferential statistics.
RESULTS
The study findings revealed that the postnatal mothers with fair and poor health
status during pregnancy had risk in fetal outcome. There was a statistically significant
correlation between the maternal wellbeing and fetal outcome at p<0.01 level of
significance. There was a statistically significant association between maternal wellbeing
with demographic variables like maternal age, occupation and nature of work; and fetal
outcome with demographic variables like maternal age, occupation and family income
per month. Similarly there was a statistically significant association between maternal
wellbeing with obstetrical variables like gravida, abortion, type of delivery, iron and folic
acid intake, maternal weight gain and BMI; and fetal outcome like type of delivery and
iron and folic acid intake.
CONCLUSION
From the results of the study, it was concluded that fair and poor maternal health
status had increased the risk of fetal outcome. The study findings showed that maternal
wellbeing and fetal outcome is related with each other. Maternal age, occupation and
nature of work had influence on maternal wellbeing and maternal age, occupation and
family income per month had influence on fetal outcome. Gravida, abortion, type of
delivery, iron and folic acid intake, maternal weight gain and BMI had influence on
maternal wellbeing and type of delivery and iron and folic acid intake had influence the
fetal outcome. As maternal health status improve the fetal outcome also improve.
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CHAPTER I
INTRODUCTION
Pregnancy and child birth is a normal physiological phenomenon. Pregnancy is a
privilege of experiencing God’s miracles on earth.
“Maternal health is a Nation’s wealth. There is a chance for the welfare of the
world only when the condition of women improves. It is not possible for a bird to fly with
only one wing” given by Swami Vivekananda.
Woman is the glory of creation. In philosophy, she symbolizes the mother aspect
of nature or feminine characteristic of the universe. Pregnancy and childbirth are special
events in women’s lives and indeed the lives of their families. It can be a time of great
hope and joyful anticipation. It can also be a time of fear, anxiety, suffering and even
death.
The World Health Organization defines, “health is a state of complete physical,
mental and social wellbeing and not merely absence of disease or infirmity”. “Maternal
health as the health of a woman during pregnancy, childbirth and postpartum period”.
Good maternal health is crucial for a healthy birth outcome for both mother and the fetus.
Staying healthy while pregnant is not only for mother’s physical and mental wellbeing,
but also for the growing baby. The goal of WHO is to ensure that healthy mothers give
birth to healthy infants.
Maternal health is a sound investment strategy and it is believed that it is
important to speak collectively, act quickly and bring about long-lasting change in
neonatal health.
2
Many women are unaware of their health before and during conception and this
may influence their risk of having an adverse outcome of the pregnancy. Pregnancy
requires constant attention to the physical wellbeing of the mother. Healthy pregnancy
can be achieved through various interventional strategies like standard care, adequate
health care providers, availability of medical resources including equipment and
medication, supportive health and family planning education programmes, nutrition
initiatives and diseases prevention. There is a growing evidence that reducing risk in the
preconception period improves the health of pregnant women and also contribute to the
prevention of adverse outcome of neonatal mortality.
To a considerable extent, the well-being of a newborn depends on the health
of the mother. Research showed that a significant number of stillbirths and neonatal
deaths could be prevented if all women were adequately nourished and received good
quality care during pregnancy, delivery, and the postpartum period.
The mother and child should be treated as one entity. The health of the mother
and the newborn are interlinked. So, the newborn health and survival depends on
appropriate maintenance of maternal health and wellbeing of the mother during
pregnancy. The provision of care to the women before and during pregnancy would allow
women to enter pregnancy in the best possible health and to have greater chances of
giving birth to a healthy baby.
BACKGROUND OF THE STUDY
Better women’s health is essential to the good health of her baby. Pregnancy can
provide an opportunity to identify existing health risk in women to prevent the future
health problems for women and their child.
3
A pregnancy is considered high risk when maternal or fetal complications are
present that could affect the health or safety of the mother or baby. It has greater effect on
woman’s condition, physiologic, social or physical state that threatens maternal or fetal
health and produces an increased chance of morbidity or mortality. Identifying a
pregnancy as high risk helps to ensure that it receives extra attention and proper care
thereby significantly decreasing maternal and neonatal morbidity and mortality rate.
Motherhood is often with both positive and negative experience, for many women
it is associated with suffering, ill-health and even death during pregnancy. Pregnancy is
one of the common state which brings many physiological changes and pregnancy
induced discomfort in the body which may complicate the pregnancy. Even women who
were healthy before getting pregnant can experience complication during pregnancy and
it causes risk for mother as well as the fetus. The risk factors of mother during pregnancy
like increased maternal age, PIH, hyperemesis gravidaraum, Gestational Diabetes
Mellitus (GDM), anemia, vaginal bleeding and discharges, medical conditions like
Diabetes Mellitus(DM), Urinary Tract Infection (UTI), thyroid dysfunction, fever, etc.
can lead to neonatal infection, birth asphyxia, preterm birth, low birth weight baby and
congenital anomalies for fetus (WHO, 2012).
The prevalence of anemic mother having preterm baby (26.15%), low birth
weight baby (48.46%), baby with lower head circumference and length is more.
Comparison of birth and 3½ month data indicates, weight gain and increase in length is
significantly better in infant of non-anemic mothers (Ektadalah, 2009).
In mothers with gestational diabetes, the prevalence of preterm deliveries (9.5%)
is higher than the other maternal risk factors. The poor control of preexisting or
gestational diabetes in pregnancy increases the neonatal risk of hypoglycemia,
hypocalcaemia, hyperbilirubinemia, organogenesis, low APGAR score (<7 at 1minute),
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congenital malformation and macrosomia (>4500gms at birth) even if blood glucose is
kept nearly normal (Mauro, J. 2014).
The maternal obesity and GDM have perinatal and neonatal effect. The in-utro
exposure to hyperglycemia increases the perinatal complications including preterm birth,
macrosomia, neonatal respiratory distress, hypoglycemia and polycythemia. Significantly
GDM places the offspring at risk of insulin resistance and type 2 DM, obesity and
cardiovascular diseases in later age (Malhotra, A&Varaka. 2014).
The International Association of Diabetes and Pregnancy Study Groups
(IADSPG) and in UK the NICE guideline reported that the women with high incidence of
GDM results in increased adverse pregnancy outcome.
Gestational Hypertension develops after 20 weeks of pregnancy and remains till 6
weeks in postpartum period. It occurs in 5-10% of pregnancies. Chronic and poor control
of blood pressure before and during pregnancy predisposes the pregnant women and her
baby at risk for complication. Uncontrolled preexisting hypertension also increases the
risk of newborn which includes fetal growth restriction, hypoxia, preterm and even infant
death (WHI-Women’s Health Initiative 2013 Report). Thyroid disorder may develop
during pregnancy. It results in fetal growth restriction, hypothyroidism, and intellectual
deficit in baby.
Most common maternal infections like UTI, skin and respiratory tract infection,
genital tract infection can cause damage to fetus like congenital cytomegalovirus, herpes
simplex virus, rubella, hepatitis or syphilis. Infections may also have chance of fetal
transmission of HIV infection and listeriosis which will increase the risk of premature
labor and in rare cases stillbirth can occur. Research evidence showed that when
compared to non-infected mother there is a greater prevalence of neonatal infection with
affected mother (Chan, J. 2013 & Lenda, A. 2011).
5
THE HINDU (2012) reported that, approximately 4 million fetal deaths occur
every year, 98% of them in developing countries of the world. In India, as many as 1.72
million children die annually before reaching 1 year and 72% die during first month of
life, the neonatal period. Maternal health is a common risk factors for fetal deaths include
advanced maternal age, chronic maternal condition such as anemia and sickle cell
disease, maternal infections such as syphilis, HIV, and malaria, stress, inadequate
maternal nutrition and maternal complication (both antepartum and Intrapartum).
According to National Centre for Health Statistics (2014), in India total number of
live births are 3,988,076, in that 8% of the infants were low birth weight and 9.6% of
them were preterm. The Ministry of Health and Family Welfare, India reported that the
maternal health and fetal outcome has various demographic indicators which include
pregnant women receiving antenatal checkups, women taking TT 2 doses with booster
dose, women having low hemoglobin, stillbirth baby, low birth weight baby and minor
disorders of newborn (WHO 2013).
NEED FOR THE STUDY
"The health of children is one of the most important measures of the wellbeing of
a society, and that starts during pregnancy and at the very beginning of life." (Coffey
Diane, 2015)
UNICEF (2014) found that healthy children need healthy mother. The health of
the mother vastly impact on the health and success of our future generation. Yearly 8
million babies die before or during delivery or in first week of life. The report says that
majority of the disease in early neonatal period is related to poor maternal health and
nutrition as well as quality of care at pregnancy.
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Globally, nearly 800 women die due to complication during pregnancy and 0.75
million neonates die due to poor fetal outcome. In that, 99% of these occur in developing
countries. Most common causes for the neonatal mortality which influence the poor fetal
outcome includes prematurity & low birth weight (44%); neonatal infection (15%); birth
asphyxia & birth trauma (19%); congenital anomalies (8%); other conditions (7%);
pneumonia (4%); tetanus (2%); diarrheal diseases (1%) and injuries (1%) (WHO, World
Bank & UNICEF, 2015).
Thangarathinam,S. et. al. (2012) in their study report showed that firstly, among
Indian Women early age of marriage (18%), repeated childbearing (47%),
malnourishment (36%) and anemia (55%) are the stunning negative factors which had an
influence on maternal and fetal outcome. Mothers with severe anemia are at increased
risk of maternal death, stillbirth, and early neonatal death; and their infants are at
increased risk of low birth weight, prematurity, and/or cognitive impairments.
Secondly, maternal health and nutrition has implications for child health. Infants
whose mothers do not weigh enough before pregnancy and who do not gain enough
weight during pregnancy, are more likely to develop risk for low birth weight and
newborn may die in the first month of life.
Thirdly, Neonatal tetanus causes more than 300,000 newborn deaths occur every
year. In the year 2014, approximately 4 million infants died in the first 28 days of life.
Immunizing women with two doses of tetanus toxoid vaccine given during pregnancy
protect the women during childbirth and it passes immunity to the fetus.
The investigator from her clinical experience noticed that the pregnant mother
with the poor weight gain pattern, low hemoglobin level, PIH, GDM had a child birth
with poor fetal outcome like preterm birth, IUGR and low birth weight baby. At the same
time few pregnant mothers had the same risk factors, but delivered a healthy baby.
7
Hence, the investigator felt that there is a need to identify whether the mother’s
physical health status before pregnancy and the existing conditions during pregnancy
influence the fetal outcome or not. So, the investigator was interested to identify the
relationship between the maternal wellbeing and fetal outcome among postnatal mothers.
STATEMENT OF THE PROBLEM
A study to assess the relationship between maternal wellbeing and fetal outcome
among postnatal mothers at selected hospitals in Chennai.
OBJECTIVES OF THE STUDY
To assess the maternal wellbeing and fetal outcome.
To correlate the maternal wellbeing and fetal outcome.
To associate the maternal wellbeing and fetal outcome with the demographic
variables like the age, education, occupation and socio economic status.
To associate the maternal wellbeing and fetal outcome with the obstetrical
variables like gravida, para, number of live children, abortion, type of delivery,
initiation of antenatal care, vaccination and iron and folic acid intake.
OPERATIONAL DEFINITIONS
ASSESS
The term assess refers to the process of gathering information regarding maternal
wellbeing and fetal outcome among postnatal mothers using questionnaire and checklist
and analyzing the data using statistical methods.
8
MATERNAL WELLBEING
Maternal wellbeing refers to the physical health of the mother during 1st, 2
nd and
3rd
trimesters of pregnancy as reviewed from the records of postnatal mother which is
assessed by using checklist.
FETAL OUTCOME
Fetal outcome refers to the health of the baby born to postnatal mothers admitted
in selected settings in terms of gestational age, APGAR, birth weight, length, head
circumference, chest circumference, congenital anomalies and reflexes which will be
assessed by using checklist.
POSTNATAL MOTHERS
Postnatal mothers refer to women who are admitted in the postnatal wards after
the delivery till 7 days in the selected settings.
HYPOTHESIS
H01- There is no relationship between maternal wellbeing and fetal outcome.
H02- There is no association between maternal wellbeing and demographic variables like
maternal age, education and socioeconomic status.
H03- There is no association between maternal wellbeing with obstetrical variables like
gravida, para, number of live children, abortion, type of delivery, iron and folic acid
intake and maternal weight gain.
H04- There is no association between fetal outcomes with demographic variables like
maternal age, education and socioeconomic status.
H05- There is no association between fetal outcomes with obstetrical variables like
gravida, para, number of live children, abortion, type of delivery, iron and folic acid
intake and maternal weight gain.
9
ASSUMPTION
Earlier the antenatal registration betters the fetal outcome.
Decreased medical disorders during pregnancy better the fetal outcome.
Decreased minor disorders during pregnancy better the fetal outcome.
DELIMITATION
The study is delimited to a period of 4 weeks of data collection at selected
hospitals.
PROJECTED OUTCOMES
The study will help to find the association on the influence of demographic
variables on maternal wellbeing and fetal outcome.
The study will help us to identify the relationship between maternal wellbeing on
fetal outcome.
The findings of the study will help the investigator to recommend on promotion
of the maternal wellbeing.
CONCEPTUAL FRAMEWORK
Conceptual frame work is simple structure of research ideas or concepts in
systematically organized manner which makes an investigator to communicate with
variables. Miles and Huberman (1994) defined a framework as a visual or written
product, one that explains, either schematically or narrative form, the key factors,
concepts or variables and presumed relationship among them.
Conceptual framework adopted for the study was based on health care model
“structure-process-outcome” framework described by Avedis Donabedian, a physician
10
and health service researcher at the University of Michigan. The framework outlines are
interconnected inputs, required at different level of health system lead to delivery of
quality care and results in positive health outcome.
Donabedian first describes the three aspects of model in his 1966 article
“evaluating the quality of medical care”. The maternal wellbeing and fetal outcome
exhibits through 3 categories were connected by unidirectional arrows.
The boxes of information represents as,
Structure
Process
Outcome
Structure
In this theory, Structure includes all factors that affect the context in which care is
delivered. Structure is often easy to observe and measure and it may be the upstream
cause of problems identified in process.
In this study, structure refers to the demographic variables such as age, education,
occupation, monthly income, residence, type of family and unhealthy habits; and
obstetrical variables such as gravida, para, abortion, type of delivery, antenatal visit,
vaccination, iron and folic acid intake and maternal weight gain.
Process
In this theory, Process is the sum of all actions that make up healthcare.
According to Donabedian, the measurement of process is nearly equivalent to the
measurement of quality of care because process contains all acts of healthcare
11
delivery. Information about process can be obtained from medical records, interviews
with patients and practitioners, or direct observations of healthcare visits.
In this study, process refers to the act of gathering information regarding maternal
wellbeing and fetal outcome. Information regarding maternal wellbeing was obtained
from review of health record and response from the postnatal mothers which includes
minor disorders during pregnancy, high risk conditions during pregnancy and existing
conditions complicating pregnancy. Information regarding fetal outcome was obtained by
review of health record and assessment of newborn includes gestational age, APGAR,
birth weight, length, head circumference, chest circumference, congenital anomalies and
reflexes.
Outcome
Outcome contains all the effects of healthcare on patients or populations,
including changes to health status, behavior, or knowledge as well as patient satisfaction
and health-related quality of life. Outcomes are sometimes seen as the most important
indicators of quality because improving patient health status is the primary goal of
healthcare.
In this study, outcome refers to the quality of life of the postnatal mothers which
is interpreted as poor health, fair health and good health. The fetal outcome is interpreted
as newborn with risk and newborn without risk.
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OUTCOME
DEMOGRAPHIC
VARIABLES
Age
Education
Occupation
Monthly Income
Residence
Type of family
Personal habits
MEDICAL
RECORD
REVIEW & SELF
REPORT
MATERNAL
WELLBEING:
Minor disorders
during
pregnancy
High risk
conditions during
pregnancy
Existing
conditions
complicating
pregnancy
PROCESS
OBSTETRICAL
VARIABLES
Obstetrical score
Type of delivery
Antenatal visit
Vaccination
Iron and folic
acid intake
Maternal weight
gain
POOR
HEALTH
FAIR
HEALTH
NEWBORN
WITH RISK
NEWBORN
WITHOUT
RISK
STRUCTURE
FIGURE 1: CONCEPTUAL FRAME WORK BASED ON
MODIFIED DONABEDIAN HEALTH CARE OUTCOME
MODEL (1966)
GOOD
HEALTH
FETAL
OUTCOME:
Assessment of
Gestational age
Growth pattern
APGAR
Birth weight
Length
Head
circumference
Chest
circumference
Congenital
anomalies
Reflexes
13
CHAPTER II
REVIEW OF LITERATURE
Review of literature is a key step in research process. It refers to an extensive,
exhaustive and systematic examination of publication relevant to the research project. For
the present study, an extensive review of relevant literature was undertaken which is
organized and presented under the following headings.
1. Studies related to maternal demographic variables and fetal outcome.
2. Studies related to minor disorders and medical conditions during pregnancy and
fetal outcome
3. Studies related to maternal health and fetal outcome.
STUDIES RELATED TO MATERNAL DEMOGRAPHIC VARIABLES AND
FETAL OUTCOME
Kozuki, et. al., (2013) conducted a study to identify the association between
parity, maternal age and adverse neonatal outcomes using data from 14 cohort studies
conducted in low and middle-income countries (LMIC).The study revealed that women
with maternal age of less than 18 years and more than 35 years had neonatal outcome of
small for gestational age (SGA), preterm, neonatal and infant mortality.
Lisonkova, et. al., (2012) conducted a retrospective cohort study of singleton
births in British Colombia. In the cohort by convenient sampling technique 69,023
women aged 20 to 29 years; 25,058 women aged 35 to 39years, and 4,816women aged 40
years and above were selected as samples. Data was obtained from database registry. The
results concluded that when compared with young aged primiparous mothers, the women
aged 35 to 39 years had increased risk of still birth, neonatal death, preterm, SGA and
14
neonatal intensive care unit admission. It revealed that majority (95%) of the neonatal
outcome differed by parity and maternal age.
Blomberg & Tyrberg. (2014) conducted a prospective study to assess the impact
of maternal age on obstetric and neonatal outcome with emphasis on primiparous
adolescents and older women. 798,732 women were taken as samples and data was
collected from Swedish Medical Birth Register. The study result showed that prematurity
had association with low maternal age and stillbirth, SGA and low APGAR score
associated with advanced maternal age.
Drehmer & Duncan. (2013) conducted a study to investigate the association
between weight gain during second and third trimester of pregnancy and fetal outcome.
Totally 2,244 antenatal women were analyzed by using structured questionnaire,
anthropometric measurement and BMI assessment. The results showed that among 2,244
women, 28.1% had insufficient weight gain, 43.4% had excessive weight gain in 2nd
trimester and 38.9% had insufficient weight gain and 39.1% had excessive weight gain
during 3rd
trimester. In relation to total weight gain during pregnancy 33.4% had
insufficient and 32.9% had excessive weight gain. The study results showed that
insufficient total weight gain was associated with higher risk of preterm birth and SGA
and excessive total weight gain was associated with higher risk of Large for Gestation
Age (LGA) and with low risk of SGA.
Lumbanraja, S. Lutan, D & Usman, I. (2013) conducted a study to describe the
maternal weight gain during all trimesters of pregnancy and its correlation with birth
weight. 104 pregnant women were selected as samples from antenatal ward. Researcher
collected data by record review and antenatal physical assessment at each trimester and
were compared with the birth weight of their babies. The results concluded that there is a
15
correlation between total maternal weight gain in second and third trimester with birth
weight of baby at p<0.05 level.
Gosavi, V & Koparkar, R. (2012) conducted a study to correlate the low birth
weight and neonatal mortality rate associated with maternal factor in Manipal. The case
reports of all mothers under 20 years of age were analyzed retrospectively. The Purposive
sampling technique was used to select samples. During the study period, a total of 6,505
women delivered, in which 455 cases were teenage pregnancy. The study findings
showed that majority (82.2%) were primigravida, 40.3% had nil or inadequate antenatal
care, 16.9% had anemia, 20% had PIH, 31% had caesarean section and 61.5% had low
birth weight. So investigator concluded that low birth weight is associated with mother of
primigravida & teenage pregnancies.
Khadilkar, V. et. al., (2016) conducted a retrospective study to assess the growth
status of small for gestational age among Indian children from two socio economic strata
in Pune and Maharashtra. Data were collected by record review with a sample size of 618
children. Majority (65.7%) of babies were SGA. In that 34.5% were from USS (Upper
Socioeconomic Strata) and 65.5% were from LSS (Lower Socioeconomic Strata). The
study results revealed that maternal factors such as inadequate diet, intrauterine infection
and inflammation had high percentage of relationship with SGA neonates under LSS
when compared to USS.
STUDIES RELATED TO MINOR DISORDERS AND MEDICAL CONDITIONS
DURING PREGNANCY AND FETAL OUTCOME
Peled, et. al., (2013) conducted a retrospective study to determine the pregnancy
outcome in hyperemesis gravidarum (HEG) and the role of fetal gender. 545 pregnant
women with hyperemesis gravidarum admitted in hospital were selected as samples by
16
Purposive sampling technique. Data were collected by record review and questionnaire
method. Investigator compared the mother with HEG having male and female fetus. The
study concluded that severe HEG is related to female fetus.
Dala. & Shah. (2014) conducted a comparative study on outcome of neonates
born to anemic mother versus non anemic mother. By using purposive sampling
technique, 130 postnatal mothers and their neonates were selected as samples at tertiary
care institute during 2009-2011. Researcher assessed and compared both group for
maturity, birth weight, hematological profile and physical growth at birth and 3 ½ month
of age. The study concluded that 13% of them were anemic mothers with preterm
deliveries, in that 26.7% of the cases had neonatal mortality.
Nisty, M. & Patil, A. (2014) conducted a prospective study to assess the maternal
and fetal outcome in pregnancy with severe anemia. Pregnant women >28 weeks of
gestational age with any parity and <7gram% of hemoglobin mothers were selected as
samples using purposive sampling technique. Totally 50 samples were monitored for
hemoglobin. Out of these sample neonates 40% were preterm, 14% with fetal growth
restriction, 8% were still birth, 34% required NICU admission and 50% babies born with
severe anemia and low birth weight.
Khosravi & Dabiran. (2014) conducted a descriptive study to assess the
prevalence of Hypertension and complications of Hypertension in pregnancy and
neonatal outcome. Mother admitted in labor ward with previous medical complication
was selected as samples by using purposive sampling technique. Data were collected
using questionnaire. Among the 1694 delivery cases examined, 173 cases had
hypertension (9.8%). Among this, 45% had gestational hypertension; 14.8% had
preeclampsia-eclampsia; 18% had preeclampsia superimposed on chronic hypertension;
13.5% cases had chronic hypertension; and 8% had pregnancy-aggravated chronic
17
hypertension. The researcher concluded that hypertensive mothers who are younger had
low birth weight babies.
Sreelakshmi, P.R. Nair, S. & Soman, B. (2015) conducted a retrospective cohort
study to assess the maternal and neonatal outcome of gestational diabetes. Totally 180
samples of which 60 women with gestational diabetes and 120 women without
gestational diabetes were selected. The mother’s antenatal history and fetal outcome data
were collected by telephonic interview using semi structured questionnaire. The findings
revealed that, nearly 48.3% of type II gestational diabetes mother’s baby had more than
3kg birth weight. In that 12.1% of neonates were admitted in In-Born Nursery (IBN).
The study concluded that major feto-maternal outcome of gestational diabetes are
increased birth weight and In-Born Nursery admission during postnatal period.
Kalra, P. Kachhwaha, P. & Singh, V. (2013) conducted a study to evaluate the
prevalence of gestational diabetes mellitus and its feto-maternal outcome in western
Rajasthan. The samples were 500 antenatal mothers in the gestational age of 24 to 28
weeks attending antenatal outpatient department (OPD). The data was collected by
questionnaire and plasma glucose level was measured. Out of 500 samples, 33 had GDM
which influenced the neonatal outcome which includes 18.1% of macrosomia, 9.09% of
stillbirth, 16.3% of hypoglycemia and 6.1% of hyperbilirubinemia.
Endale, T.Fentahun, N. & Gemada, D. (2013) conducted a retrospective cross
sectional study to detect the maternal and fetal outcome associated with PROM among
term pregnant women. Data was obtained using checklist from 4,525 women, 185
mothers with the complete history of PROM was taken as a samples. Among 185
neonates, 47% had first minute APGAR score below normal, 3.8% were stillbirth and
11.9% died. So the investigator concluded that PROM associated with unfavorable fetal
outcome.
18
Nazarpour, S. & Tehrani, F. (2015) conducted a prospective study to review the
impact of thyroid dysfunction on pregnancy and neonatal outcome. The researcher
reviewed various studies and articles that include randomized clinical trials, cohort
(retrospective and prospective) case control and case reports. From 4480 citations author
got 512 related articles; in that 130 studies had overt hypothyroidism, 203 had subclinical
hypothyroidism, 69 had overt hyperthyroidism, 43 had subclinical hyperthyroidism and
67 had thyroid immunity. The result of the study stated that overt hyperthyroidism has
effect on fetal outcome that includes preterm and intrauterine growth retardation; and for
overt hypothyroidism associated with premature birth, low birth weight, intrauterine fetal
death and neonatal distress. The result summarized that overt hyperthyroidism and
hypothyroidism has effect on pregnancy and fetal outcome.
Khalesi, N. & Khosravi, N. (2014) conducted a cross sectional study to assess the
relationship between maternal urinary tract infection (UTI) during pregnancy and
neonatal UTI. Totally 80 neonates were divided into study (with UTI 40) and the control
(without UTI 40) group. Data collected by interview method and urine analysis for
neonates. The study findings revealed that 49.9% of neonates with UTI had mother with
history of UTI during pregnancy.
Pandey, K. & Verma.K (2016) conducted a retrospective study to assess the
maternal and fetal outcome of cardiac disease in pregnancy. Totally 117 samples were
selected by purposive sampling technique. Structured questionnaire was used for data
collection. The study findings showed that, 82.1% had rheumatic heart disease, 53.1%
had mitral stenosis and 19.6% had congestive heart failure. The neonatal outcome
showed 12.8% were small for gestational age, 28.2% were admitted in NICU and 7.7%
died. The study concluded that preexisting maternal cardiac disease had relationship with
feto-maternal outcome.
19
STUDIES RELATED TO MATERNAL HEALTH AND FETAL OUTCOME
Jammeh, A. Sundby, J. & Vangen, S. (2011) conducted a cross sectional
retrospective study to determine the maternal and obstetric risk factor for low birth
weight and preterm birth among hospital births in rural Gambia. Out of 1579 pregnant
women delivered in that hospital, 10.5% were LBW and 10.9% were Preterm babies
(PTB). They were correlated with parity, antepartum hemorrhage and hypertension
disorder during pregnancy. The study concluded that pregnancy complicated by
antepartum hemorrhage and hypertensive disorder pregnancy was highly associated with
risk of PTB & LBW babies.
Gosavi, V. & Koparkar, R. (2014) conducted a retrospective study to assess the
maternal factors for low birth weight from maternal health care in rural hospital, Wardha.
Data were collected from delivery records about maternal age, parity, childbirth weight
and sex of child from 2005-2010. Among 455 neonates, 24.4% were low birth weight
which is commonly higher in female babies and teenage pregnancies. Researcher
concluded that maternal age and sex of newborn had significant association with low
birth weight.
Mashuda, F. & Zuechner, A. (2014) conducted a cross sectional study to assess
the pattern and factors associated with congenital anomalies among young infants (<2
months) admitted in hospital. Totally 445 infants with and without congenital anomalies
were taken by using face to face interview with parent or care taker data collection was
obtained. Among them 29% neonate were found with congenital anomalies. The study
concluded that there was a significant association between congenital anomalies and lack
of peri-conceptional use of folic acid.
20
Khan, A. Zuhaid, M. & Fayaz, M. (2015) conducted a cross sectional study to
assess the frequency of congenital anomalies in newborn and its relation to maternal
health in tertiary care hospital in Peshawar, Pakistan. Out of 1062 deliveries, 2.9% had
various congenital anomalies hydrocephalus 22.6%, anencephaly 12.9% and spina bifida
9.7%. Researcher concluded that low intake of folic acid and high consanguinity rate
were associated with congenital anomalies.
21
CHAPTER III
METHODOLOGY
A correlational study was undertaken to assess the maternal wellbeing and fetal
outcome among postnatal mothers at selected hospitals, Chennai.
This chapter on methodology deals with the description of research approach and
design, study setting, population, sample, criteria for sample selection, sampling size,
sample technique, data collection tool, validity of tool, reliability, pilot study, data
collection procedure and plan for data analysis.
22
SCHEMATIC REPRESENTATION OF METHODOLOGY
Figure 2. Schematic representation of the study
RESEARCH APPROACH
Evaluative in nature
RESEARCH DESIGN
Descriptive Design
SETTING OF THE STUDY
CSI Kalyani Multispeciality Hospital &
Pankajam Memorial Hospital, Chennai,
TARGET POPULATION
Postnatal Mothers and their Babies
SAMPLES
Postnatal mothers and their Babies who fulfilled the inclusion criteria
SAMPLING TECHNIQUE
Non probability convenient sampling technique
SAMPLE SIZE 120 Postnatal mothers and their Babies
DATA COLLECTION METHOD & TOOL
Interview, Record Review and Checklist
DATA ANALYSIS
Descriptive statistics such as Frequency and percentage distribution. Inferential
Statistics such as Correlation coefficient and chi-square test.
23
RESEARCH APPROACH
The research approach was evaluative in nature.
RESEARCH DESIGN
A descriptive design was chosen for the study.
MAJOR VARIABLES OF THE STUDY
The major variables of the study were maternal wellbeing and fetal outcome.
RESEARCH SETTING
The study was conducted in hospitals like
CSI Kalyani Multispecialty Hospital: It is 250 bedded hospitals at Mylapore,
Chennai. This hospital provides various services, such as antenatal screening for normal
and high risk mothers, treating medical conditions complicating pregnancy, postnatal
care, neonatal care, immunization, etc.
Pankajam Memorial Hospital: It is a 50 bedded hospital at Nanganallor,
Chennai. This hospital offers various services such as pregnancy monitoring,
complication in pregnancy, postnatal services, neonatal care, immunization, etc.
POPULATIONOF THE STUDY
Population for the study included all postnatal mothers and their babies in the
selected Hospitals, Chennai.
SAMPLE
The postnatal mothers and their babies who fulfilled the inclusion criteria were
selected as samples.
24
CRITERIA FOR THE SELECTION OF SAMPLES
INCLUSION CRITERIA
1) Mothers who are willing to participate in the study.
2) Mothers with baby who are in early postnatal period of 7 days from delivery.
3) Mothers who had delivered normal vaginal delivery, forceps and vacuum delivery
and cesarean section.
4) Mothers who can understand English or Tamil.
5) All primi and multipara mothers with the viable baby.
EXCLUSION CRITERIA
1) Mothers who are not registered.
2) Mothers with the incomplete records of pregnancy.
3) Mothers with labour and obstetrical complications.
4) Mothers with critically ill baby.
5) Mothers with infertility treatment.
6) Samples of pilot study.
SAMPLE SIZE
From the population, samples of 120 postnatal mothers and their babies were
selected.
SAMPLING TECHNIQUE
Non Probability convenient sampling technique was used to select the postnatal
mothers and their babies from the population.
25
TOOL FOR DATA COLLECTION
Structured questionnaire and Checklist was used to collect data. It consists of
three parts.
PART I
SECTION A
It consisted of structured questionnaire to elicit the demographic data of postnatal
mother like age, religion, education, occupation, residence, monthly income, type of
family and personal habits.
SECTION B
It consisted of structured questionnaire to elicit the obstetrical data of postnatal
mother like gravida, para, number of live children, abortion, type of delivery, initiation of
antenatal care, vaccination, iron and folic acid intake, maternal weight gain and BMI at
term.
PART II
MATERNAL WELLBEING
Maternal wellbeing was assessed using checklist, mothers response was obtained
on minor disorders and antenatal record review was done to assess the high risk
conditions during pregnancy and pre-existing conditions complicating pregnancy.
SCORING AND INTERPRETATION
Checklist (Yes or No) was used to assess the maternal wellbeing. It consists of 15
statements, each item was scored as
Option Score
Yes 1
No 0
26
The maximum score is 42. As the score increases the risk increases and total score were
arbitrarily classified as
Scores Interpretation
>75% Poor health
50-75% Fair health
<50% Good health
PART III
FETAL OUTCOME
Checklist was used to assess the fetal outcome. Length, head, chest circumference
and reflexes were assessed and neonatal record review was done to obtain data regarding
gestational age, intrauterine growth pattern, APGAR, birth weight and congenital
anomalies.
SCORING AND INTERPRETATION
Checklist (Yes or No) was used to assess the fetal outcome. It consists of 10
statements, each scored as
Option Score
Yes 1
No 0
The maximum score is 25and total score were arbitrarily classified as
Scores Interpretation
<50% No risk
>50% Risk
27
VALIDITY OF THE TOOL
The tool was validated by five experts, one Obstetrician, one Neonatologist and
three Obstetrics and Gynecology Nursing experts.
RELIABILITY OF THE TOOL
The reliability of the tool was calculated by inter rater method. The reliability
correlation coefficient values are 0.81 for maternal wellbeing and 0.86 for fetal outcome.
HUMAN RIGHTSAND ETHICAL CONSIDERATION
The study was approved by the ethical committee constituted by the college.
Permission was obtained from the concerned authority of selected hospitals in Chennai.
The informed consent was obtained from the samples for their willingness to participate
in the study.
PILOT STUDY
The study was conducted from 11.07.2016 to 16.07.2016 at Kalyani
Multispeciality Hospital, Chennai and Pankajam Memorial Hospital, Nanganallur. After
obtaining approval from the research committee in the college, permission was obtained
from the concerned authority to conduct the study. Informed consent was obtained from
the samples. Samples fulfilling the inclusion criteria were selected using non probability
convenient sampling technique. Demographic data and obstetrical data were obtained
from the postnatal mothers by interview method. Maternal wellbeing was assessed using
checklist, mothers response was obtained on minor disorders and antenatal record review
was done to assess the high risk conditions during pregnancy and pre-existing conditions
complicating pregnancy. Fetal outcome was assessed using checklist. Length, head, chest
28
circumference and reflexes were assessed and neonatal record review was done to obtain
data regarding gestational age, intrauterine growth pattern, APGAR, birth weight and
congenital anomalies. It took approximately 30 minutes to collect data from each sample.
PILOT STUDY RECOMMENDATIONS
There were no practical difficulties experienced in the sample selection. The tool
was feasible and the main study was carried out without any modification of pilot study.
DATA COLLECTION METHODS
The data for the main study was collected from 01.11.2016 to 28.11.2016 at CSI
Kalyani Multispeciality Hospital, Chennai and Pankajam Memorial Hospital,
Nanganallor. After obtaining approval from the research committee in the college,
permission was obtained from the concerned authority to conduct the study. Informed
consent was obtained from the samples. Samples fulfilling the inclusion criteria were
selected using non probability convenient sampling technique. After self-introduction and
establishing rapport with the samples, brief introduction about the study was given.
Demographic data and obstetrical data was obtained from the postnatal mothers by
interview method. Maternal wellbeing was assessed using checklist, mothers’ response
was obtained on minor disorders and antenatal record review was done to assess the high
risk conditions during pregnancy and pre-existing conditions complicating pregnancy.
Fetal outcome was assessed using checklist. Length, head, chest circumference and
reflexes were assessed and neonatal record review was done to obtain data regarding
gestational age, intrauterine growth pattern, APGAR, birth weight and congenital
anomalies. It took approximately 30 minutes to collect data from each sample.
29
PLAN FOR DATA ANALYSIS
Data analysis was done using descriptive and inferential statistics
Descriptive Statistics
Frequency and percentage distribution was used to describe the demographic
variables and obstetrical variables.
Frequency and percentage distribution was used to describe the maternal
wellbeing and fetal outcome.
Inferential Statistics
Coefficient correlation was used to correlate the maternal wellbeing and fetal
outcome among postnatal mothers.
Chi square test was used to associate the maternal wellbeing with the
demographic variables and the obstetrical variables.
Chi square test was used to associate the fetal outcome with the demographic
variables and the obstetrical variables.
30
CHAPTER IV
DATA ANALYSIS AND INTERPRETATION
Data analysis and interpretation is the core step in the research process. The
importance of analysis and interpretation of the collected data is to systematically
organize, classify and summarize it so that the results can be interpreted to give all the
results that trigged the research. In this chapter a detailed analysis of the collected data
has been done as per the objectives stated earlier.
The data obtained were classified and was presented under the following sections
SECTION I: Frequency and percentage distribution of the postnatal mothers based on
the demographic variables.
SECTION II: Frequency and percentage distribution of the postnatal mothers based on
the obstetrical variables.
SECTION III: Assessment of the maternal wellbeing and fetal outcome of the postnatal
mothers and her babies.
SECTION IV: Correlation of maternal wellbeing and fetal outcome among the postnatal
mothers.
SECTION V: Association of maternal wellbeing and fetal outcome with demographic
variables of the postnatal mothers.
SECTION VI: Association of maternal wellbeing and fetal outcome with obstetrical
variables of the postnatal mothers.
31
SECTION I
FREQUENCY AND PERCENTAGE DISTRIBUTION OF THE POSTNATAL
MOTHERS BASED ON DEMOGRAPHIC VARIABLES.
Table 1.1: Frequency and percentage distribution of the postnatal mothers based on
demographic variables such as age in years, educational status, occupation and type
of work.
N=120
S.No. DEMOGRAPHIC VARIABLES FREQUENCY
(F)
PERCENTAGE
(%)
1. Age in years
a) <21 years
b) 21-30 years
c) 31-40 years
23
74
23
19.2
61.6
19.2
2. Education status
a) No formal education
b) Literate
If literate,
i) Primary school
ii) High school
iii) Secondary education
iv) Degree
14
106
17
31
32
26
11.7
88.3
16.1
29.2
30.2
24.5
3. Occupation
a) Unemployed
b) Employed
If employed,
i) Government
ii) Private
iii) Business
iv) Daily wages
60
60
16
26
10
8
50.0
50.0
26.7
43.3
16.7
13.3
4. Type of work
a) Sedentary worker
b) Moderate worker
c) Heavy worker
30
74
16
25.0
61.7
13.3
Table 1.1 shows that, majority (61.6%) of the mothers were in the age group of 21-30
years and 88.3% of mothers were literate in that 16.1% had primary school, 29.2% had
high school, 30.2% had secondary education and 24.5% were degree holders. Equal
numbers of the mothers were unemployed and employed in that, 26.7% were employed
in government, 43.3% were employed in private job, 16.7% were doing business and
13.3% were daily wages. Majority (61.7%) of the mothers were moderate type of workers
32
Table 1.2: Frequency and percentage distribution of the postnatal mothers based on
demographic variables such as family income per month, religion, residence, type of
family and personal habits.
N=120
S.No. DEMOGRAPHIC
VARIABLES
FREQUENCY (F) PERCENTAGE (%)
5. Family Income per month
a) < Rs.10,000
b) Rs.10,000 – Rs.15,000
c) Rs. 15,000 – Rs. 20,000
d) >Rs. 20,000
44
48
20
8
36.6
40.0
16.7
6.7
6. Religion
a) Hindu
b) Christian
c) Muslim
75
33
12
62.5
27.5
10.0
7. Residence
a) Urban
b) Rural
120
0
100.0
0.0
8. Type of family
a) Nuclear family
b) Joint family
c) Extended family
87
21
12
72.5
17.5
10.0
9. Personal habits
a) Betel chewing
b) Smoking
c) Alcohol consumption
d) None
0
0
0
120
0.0
0.0
0.0
100.0
Table 1.2 shows that, Majority (40%) of the mothers family income was Rs.10, 000-
Rs.15,000. Majority (62.5%) of the mothers were Hindus, all (100%) mothers were
residing in urban area. Majority (72.5%) of the mothers were from nuclear family and
none of the mothers had the habit of betel chewing, smoking and alcohol consumption.
33
SECTION II
FREQUENCY AND PERCENTAGE DISTRIBUTION OF OBSTETRICAL
VARIABLES AMONG THE POSTNATAL MOTHERS
Table 2.1: Frequency and percentage distribution of the postnatal mothers based on
obstetrical variables such as gravida, para, number of live children and abortion.
N=120
S.No. OBSTETRICAL
VARIABLES FREQUENCY (F) PERCENTAGE (%)
1. Gravida
a) Primigravida
b) Multigravida
c) Grand multigravida
41
70
9
34.2
58.3
7.5
2. Para
a) Primipara
b) Multipara
c) Grand multipara
71
47
2
59.2
39.2
1.6
3.
No. of live children
a) 1 child
b) 2 child
c) >3 child
81
35
4
67.5
29.2
3.3
4.
History of Abortion
a) 0
b) 1
c) > 2
78
26
16
65.0
21.7
13.3
Table 2.1 shows that, majority (58.3%) were multigravida mothers, 59.2% of them were
primipara mothers, 67.5% had one child and 65% had no abortion, 21.7% had one
abortion and 13.3% had >2 abortion.
34
Table 2.2:Frequency and percentage distribution of the postnatal mothers based on
obstetrical variables such as type of delivery, initiation of antenatal care,
vaccination, iron and folic acid intake, maternal weight gain and BMI at term.
N=120
S.No, OBSTETRICAL VARIABLES FREQUENCY (F) PERCENTAGE (%)
5. Type of delivery
a) Normal vaginal delivery
b) Forceps delivery
c) Vacuum delivery
d) Cesarean section
62
6
15
37
51.7
5.0
12.5
30.8
6. Initiation of antenatal care
a) < 12 weeks
b) > 12 weeks
120
0
100.0
0.0
7. Vaccination (Tetanus toxoid)
a) Vaccinated
b) Not vaccinated
120
0.0
100.0
0.0
8. Iron and folic acid intake
a) Regular
b) Irregular
77
43
64.2
35.8
9. Maternal weight gain
a) < 10kg
b) 10 – 12kg
c) >12kg
84
26
10
70.0
21.7
8.3
10. BMI at term
a) Normal 18.5-24.9
b) Overweight 25-29.9
c) Obesity greater than 30
49
52
19
40.8
43.4
15.8
Table 2.2 shows that, majority (51.7%) of mothers had undergone normal vaginal
delivery and 30.8% had cesarean section. All (100%) mothers initiated antenatal care in
<12 weeks and were vaccinated. Majority (64.2%) of mothers had taken iron and folic
acid regularly. Majority (70%) of mother had <10kg of weight gain and 43.3% of the
mothers had over weight.
35
SECTION III
ASSESSMENT OF THE MATERNAL WELLBEING AND FETAL OUTCOME
AMONG THE POSTNATAL MOTHERS
Table 3.1: Frequency and percentage distribution of maternal wellbeing status
among the postnatal mothers.
N=120
Table 3.1 shows that, majority (53.3%) of mothers had good health, 31.7% of them had
fair health and 15% of the mother had poor health.
S. No
VARIABLE
GOOD HEALTH FAIR HEALTH POOR HEALTH
F % F % F %
1 Maternal wellbeing 64 53.3 38 31.7 18 15.0
36
Table 3.2: Frequency and percentage distribution of the fetal outcome among
neonates.
N=120
Table 3.2 shows that, majority (72.5%) of newborn babies had risk and 27.5% had no
risk.
S.No. VARIABLE NO RISK RISK
F % F %
1 Fetal outcome 33 27.5 87 72.5
37
SECTION IV
TABLE 4: CORRELATION OF MATERNAL WELLBEING AND FETAL
OUTCOME AMONG THE POSTNATAL MOTHERS.
N=120
S.NO. VARIABLES CORELATION COEFFICIENT VALUE
1. Maternal wellbeing r = 0.257
p = 0.01**S 2. Fetal outcome
* p<0.05, **p<0.01, ***p<0.001 S - Significant NS - Not Significant
Table 4: shows that, there was a low positive correlation between maternal wellbeing and
fetal outcome at p<0.01 level of significance.
38
Figure 3: Correlation of percentage distribution on maternal wellbeing and fetal outcome.
0%
5%
10%
15%
20%
25%
30%
35%
GOOD FAIR POOR
MATERNAL WELLBEING
25
.8%
0.8
%
0.8
%
27
.5%
30
.8%
14
.3%
% o
f m
oth
ers
Percentage distribution of maternal wellbeing and fetal outcome
Fetal outcome Fetal outcome
39
SECTION V
ASSOCIATION OF MATERNAL WELLBEING AND FETAL OUTCOME WITH
DEMOGRAPHIC VARIABLES OF THE POSTNATAL MOTHERS.
Table 5.1: Association of maternal wellbeing with demographic variables such as
age, education, occupation and nature of work among the postnatal mothers.
N=120
S.
No.
DEMOGRAPHIC
VARIABLES
Maternal wellbeing Chi square
test Good health Fair health Poor health
(F) (%) (F) (%) (F) (%)
1. Age in years
a) <21 years
b) 21-30 years
c) 31-40 years
5
52
7
4.2
43.4
5.8
11
15
12
9.2
12.5
10.0
7
7
4
5.8
5.8
3.3
2=23.787
d.f=4
p=0.001
S***
2. Education status
a) No formal education
b) Literate
If literate,
i) Primary school
ii) High school
iii) Secondary
education
iv) Degree
6
58
6
16
19
17
5.0
48.3
5.7
15.1
17.9
16.0
5
33
7
11
9
6
4.2
27.5
6.6
10.3
8.5
5.7
3
15
4
4
4
3
2.5
12.5
3.8
3.8
3.8
2.8
2=5.345
d.f = 8
p=0.720
N.S
3. Occupation
a) Unemployed
b) Employed
If employed,
i) Government
ii) Private
iii) Business
iv) Daily wages
30
34
12
16
4
2
25.0
28.4
20.0
26.7
6.7
3.3
25
13
1
6
4
2
20.8
10.8
1.6
10.0
6.7
3.3
5
13
3
4
2
4
4.2
10.8
5.0
6.7
3.3
6.7
2=18.126
d.f=8
p=0.020
S*
4. Nature of work
a) Sedentary worker
b) Moderate worker
c) Heavy worker
17
44
3
14.2
36.7
2.5
10
22
6
8.3
18.3
5.0
3
8
7
2.5
6.7
5.8
2=14.640
d.f=4
p=0.006
S**
* p<0.05, **p<0.01, ***p<0.001 S - Significant NS - Not Significant
Table 5.1 shows that, there was a statistically significant association between the
maternal wellbeing with age at p<0.001 level, occupation at p<0.05 level and nature of
work at p<0.01 level and there was no statistically significant association between
maternal wellbeing with educational status.
40
Figure 4: Percentage distribution of demographic variables such as age, occupation and nature of work based on maternal wellbeing.
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
<21 years21-30 years31-40 years UnemployedEmployed SedentaryModerate Heavy
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE] [CELLRANGE] [CELLRANGE]
[CELLRANGE] [CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE] [CELLRANGE] % o
f m
oth
ers
AGE, OCCUPATION AND NATURE OF WORK
41
Table 5.2: Association of maternal wellbeing with demographic variables such as
family income per month, religion, residence, type of family and personal habits
among the postnatal mothers.
N=120
S.
No.
DEMOGRAPHIC
VARIABLES
Maternal wellbeing Chi
square
test
Good health Fair health Poor health
(F) (%) (F) (%) (F) (%)
5. Income per month
a) < Rs.10,000
b) Rs.10,000-Rs.15,000
c) Rs.15,000–Rs.20,000
d) >Rs. 20,000
18
27
15
4
15.0
22.5
12.5
3.4
16
15
4
3
13.3
12.5
3.4
2.5
10
6
1
1
8.3
5.0
0.8
0.8
2=7.700
d.f=6
p=0.261
N.S
6. Religion
a) Hindu
b) Christian
c) Muslim
43
15
6
35.8
12.5
5.0
21
13
4
17.5
10.8
3.3
11
5
2
9.2
4.2
1.7
2=1.614
d.f=4
p=0.806
N.S
7. Residence
a) Urban
b) Rural
64
0
53.3
0.0
38
0
31.7
0.0
18
0
15.0
0.0
2=3.673
d.f=2
p=0.159
N.S
8. Type of family
a) Nuclear family
b) Joint family
c) Extended family
48
13
3
40.0
10.8
2.5
25
7
6
20.8
5.8
5.0
14
1
3
11.8
0.8
2.5
2=6.015
d.f=4
p=0.198
N.S
9. Personal habits
a) Betel chewing
b) Smoking
c) Alcohol consumption
d) None
0
0
0
64
0.0
0.0
0.0
53.3
0
0
0
38
0.0
0.0
0.0
31.7
0
0
0
18
0.0
0.0
0.0
15.0
2=3.673
d.f=2
p=0.159
N.S
* p<0.05, **p<0.01, ***p<0.001 S - Significant NS - Not Significant
Table 5.2 shows that, there was no statistically significant association between the
maternal wellbeing with demographic variables such as family income per month,
religion, residence, type of family and personal habit.
42
Table 5.3: Association of fetal outcome with demographic variables such as age,
education, occupation and family income per month among the postnatal mothers.
N=120
S.No. DEMOGRAPHIC
VARIABLES
Fetal outcome Chi square
test Risk No risk
(F) (%) (F) (%)
1. Age in years
a) <21 years
b) 21-30 years
c) 31-40 years
d) >40 years
0
30
3
0
0.0
25.0
2.5
0.0
23
44
20
0
19.1
36.7
16.7
0.0
2=17.447
d.f = 2
p=0.001
S***
2. Education status
a) No formal education
b) Literate
If literate,
i) Primary school
ii) High school
iii) Secondary education
iv) Degree
2
31
1
9
11
10
1.7
25.8
0.9
8.5
10.3
9.4
12
75
16
22
21
16
10.0
62.5
15.1
20.9
19.8
15.1
2=7.573
d.f=4
p=0.109
N.S
3. Occupation
a) Unemployed
b) Employed
If employed,
i) Government
ii) Private
iii) Business
iv) Daily wages
14
19
7
11
0
1
11.7
15.8
11.7
18.3
0.0
1.6
46
41
9
15
10
7
38.3
34.2
15.0
25.0
16.7
11.7
2=10.197
d.f=4
p=0.037
S*
4. Nature of work
a) Sedentary worker
b) Moderate worker
c) Heavy worker
11
21
1
9.2
17.5
0.8
19
53
15
15.8
44.2
12.5
2=4.917
d.f=2
p=0.086
N.S
5. Income per month
a) < Rs.10,000
b) Rs.10,000 – Rs.15,000
c) Rs. 15,000 – Rs. 20,000
d) >Rs. 20,000
6
15
9
3
5.0
12.5
7.5
2.5
38
33
11
5
31.6
27.5
9.2
4.2
2=8.054
d.f=3
p=0.045
S*
* p<0.05, **p<0.01, ***p<0.001 S - Significant NS - Not Significant
Table 5.3 shows that, there was a statistically significant association between fetal
outcome with maternal age at p<0.001 level, occupation and family income per month at
p<0.05 level and there was no statistically significant association between fetal outcome
of postnatal mothers with demographic variables such as educational status and nature of
work.
43
Figure 5: Percentage distribution of demographic variables such as age, occupation and income of the family based on fetal outcome.
0%
5%
10%
15%
20%
25%
30%
35%
40%
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
% o
f m
oth
ers
AGE, OCCUPATION AND INCOME OF FAMILY
44
Table 5.4: Association of fetal outcome with demographic variables such as religion,
residence, type of family and personal habits among the postnatal mothers.
N=120
S.No. DEMOGRAPHIC
VARIABLES
Fetal outcome
Chi square
test
Risk No risk
(F) (%) (F) (%)
6. Religion
a) Hindu
b) Christian
c) Muslim
20
10
3
16.7
8.3
2.5
55
23
9
45.8
19.2
7.5
2=0.194
d.f = 2
p=0.908
N.S
7. Residence
a) Urban
b) Rural
33
0
27.5
0.0
87
0
72.5
0.0
2=3.673
d.f = 2
p=0.159
N.S
8. Type of family
a) Nuclear family
b) Joint family
c) Extended family
27
5
1
22.5
4.2
0.8
60
16
11
50.0
13.3
9.2
2=2.900
d.f = 2
p=0.235
N.S
9. Personal habits
a) Betel chewing
b) Smoking
c) Alcohol consumption
d) None
0
0
0
33
0.0
0.0
0.0
27.5
0
0
0
87
0.0
0.0
0.0
72.5
2=3.673
d.f = 2
p=0.159
N.S
* p<0.05, **p<0.01, ***p<0.001 S - Significant NS - Not Significant
Table 5.4 shows that, there was no statistically significant association between fetal
outcome with demographic variables such as religion, residence, type of family and
personal habits.
45
SECTION VI
ASSOCIATION OF MATERNAL WELLBEING AND FETAL OUTCOME WITH
DEMOGRAPHIC VARIABLES OF THE POSTNATAL MOTHERS.
Table 6.1: Association of maternal wellbeing with obstetrical variables such as
gravida, para, number of live children and abortion among the postnatal mothers.
N=120
S.
No.
OBSTETRICAL
DATA
Maternal wellbeing
Chi
square
test
Good
health Fair health Poor
health
(F) (%) (F) (%) (F) (%)
1 Gravida
a) Primigravida
b) Multigravida
c) Grand
multigravida
27
36
1
22.5
30.0
0.8
13
20
5
10.8
16.7
4.2
1
14
3
0.8
11.7
2.5
2=13.591
d.f=4
p=0.009
S**
2 Para
a) Primipara
b) Multipara
c) Grand multipara
39
25
0
32.5
20.8
0.0
23
14
1
19.2
11.7
0.8
9
8
1
7.5
6.7
0.8
2=3.394
d.f=4
p=0.494
N.S
3 No. of live children
a) 1 child
b) 2 child
c) >3 child
39
23
2
32.5
19.2
1.7
26
11
1
21.7
9.2
0.8
16
1
1
13.3
0.8
0.8
2=6.411
d.f=4
p=0.170
N.S
4 Abortion
a) 0
b) 1
c) > 2
52
8
4
43.3
6.7
3.3
22
10
6
18.3
8.3
5.0
4
8
6
3.3
6.7
5.0
2=23.114
d.f=4
p=0.001
S***
* p<0.05, **p<0.01, ***p<0.001 S - Significant NS - Not Significant
Table 6.1shows that, there was a statistically significant association between maternal
wellbeing with gravida at p<0.01 level, abortion at p<0.001 level and there was no
statistically significant association between maternal wellbeing of postnatal mothers with
obstetrical variables such as para and number of live children.
46
Table 6.2: Association of maternal wellbeing with obstetrical variables such as type
of delivery, initiation on of antenatal care, vaccination, iron and folic acid intake,
maternal weight gain and BMI among the postnatal mothers.
N=120
S.
No.
OBSTETRICAL
VARIABLES
Maternal wellbeing Chi square
test Good health Fair health Poor health
(F) (%) (F) (%) (F) (%)
5. Type of delivery
a) Normal vaginal delivery
b) Forceps delivery
c) Vacuum delivery
d) Cesarean section
51
2
3
8
42.5
1.6
2.5
6.7
8
1
8
21
6.7
0.8
6.7
17.5
3
3
4
8
2.5
2.5
3.3
6.7
2=48.786
d.f=6
p=0.001
S***
6. Initiation of antenatal care
a) < 12 weeks
b) > 12 weeks
64
0
53.3
0.0
38
0
31.7
0.0
18
0
15.0
0.0
2=3.673
d.f=2
p=0.159
N.S
7. Vaccination (Tetanus toxoid)
a) Vaccinated
b) Not vaccinated
64
0
53.3
0.0
38
0
31.7
0.0
18
0
15.0
0.0
2=3.673
d.f=2
p=0.159
N.S
8. Iron and folic acid intake
a) Regular
b) Irregular
58
6
48.3
5.0
10
28
8.3
23.4
9
9
7.5
7.5
2=44.734
d.f=2
p=0.001
S***
9. Maternal weight gain
a) < 10kg
b) 10 – 12kg
c) >12kg
41
22
1
34.3
18.3
0.8
30
3
5
25.0
2.5
4.2
13
1
4
10.8
0.8
3.3
2=19.772
d.f=4
p=0.001
S***
10. BMI at term
a) Normal 18.5-24.9
b) Overweight 25-29.9
c) Obesity greater than 30
34
27
3
28.3
22.5
2.5
11
20
7
9.2
16.7
5.8
4
5
9
3.3
4.2
7.5
2=25.446
d.f=4
p=0.001
S***
* p<0.05, **p<0.01, ***p<0.001 S - Significant NS - Not Significant
Table 6.2 shows that, there was a statistically significant association between maternal
wellbeing with type of delivery, iron and folic acid intake, maternal weight gain and BMI
at p<0.001 level and there was no statistically significant association between maternal
wellbeing with other demographic variables such as early initiation of antenatal care and
vaccination.
47
Figure 6: Percentage distribution of obstetric variables such asgravida, abortion, type of delivery, iron and folic acid intake, maternal
weight gain and BMI based on maternal wellbeing.
0%
10%
20%
30%
40%
50%
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE] [CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE] [CELLRANGE]
[CELLRANGE] [CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE] [CELLRANGE]
[CELLRANGE]
[CELLRANGE] [CELLRANGE]
[CELLRANGE] [CELLRANGE]
[CELLRANGE] [CELLRANGE] [CELLRANGE]
[CELLRANGE]
[CELLRANGE] [CELLRANGE]
[CELLRANGE] [CELLRANGE] [CELLRANGE]
% o
f m
oth
ers
GRAVIDA, ABORTION, TYPE OF DELIVERY, IRON AND FOLIC ACID, WEIGHT GAIN AND BMI
48
Table 6.3: Association of fetal outcome with obstetrical variables such as gravida,
para, number of live children and abortion among the postnatal mothers.
N=120
S.No.
OBSTETRICAL DATA
Fetal outcome Chi square
test Risk No risk
(F) (%) (F) (%)
1. Gravida
a) Primigravida
b) Multigravida
c) Grand multigravida
15
16
2
12.5
13.3
1.7
26
54
7
21.7
45.0
5.8
2=2.580
d.f = 2
p=0.275
N.S
2. Para
a) Primipara
b) Multipara
c) Grand multipara
23
10
0
19.2
8.3
0.0
48
37
2
40.0
30.8
1.7
2=2.525
d.f = 2
p=0.283
N.S
3. No of live children
a) 1 child
b) 2 child
c) >3 child
23
9
1
19.2
7.5
0.8
58
26
3
48.3
21.7
2.5
2=0.101
d.f = 2
p=0.951
N.S
4. Abortion
a) 0
b) 1
c) > 2
25
5
3
20.8
4.2
2.5
53
21
13
44.2
17.5
10.8
2=2.317
d.f = 2
p=0.314
N.S
* p<0.05, **p<0.01, ***p<0.001 S - Significant NS - Not Significant
Table 6.3 shows that, there was no statistically significant association between fetal
outcome with obstetrical variables such as gravida, para, number of live children and
abortion.
49
Table 6.4: Association of fetal outcome with obstetrical variables such as type of
delivery, initiation of antenatal care, vaccination, iron and folic acid intake,
maternal weight gain and BMI among the postnatal mothers.
N=120
S.No. OBSTETRICAL VARIABLES
Fetal outcome Chi square
test Risk No risk
(F) (%) (F) (%)
5. Type of delivery
a) Normal vaginal delivery
b) Forceps delivery
c) Vacuum delivery
d) Cesarean section
27
2
0
4
22.5
1.7
0.0
3.3
35
4
15
33
29.2
3.3
12.5
27.5
2=18.970
d.f=3
p=0.001
S***
6. Initiation of antenatal care
a) < 12 weeks
b) > 12 weeks
33
0
27.5
0.0
87
0
72.5
0.0
2=3.673
d.f=2
p=0.159
N.S
7. Vaccination (Tetanus toxoid)
a) Vaccinate
b) Not vaccinated
33
0
27.5
0.0
87
0
72.5
0.0
2=3.673
d.f=2
p=0.159
N.S
8. Iron and folic acid intake
a) Regular
b) Irregular
31
2
25.8
1.7
46
41
38.3
34.2
2=17.548
d.f=1
p=0.001
S***
9. Maternal weight gain
a) < 10kg
b) 10 – 12kg
c) >12kg
20
11
2
16.6
9.2
1.7
64
15
8
53.3
12.5
6.7
2=3.715
d.f=2
p=0.156
N.S
10 BMI at term
a) Normal 18.5-24.9
b) Over weight 25-29.9
c) Obesity greater than 30
17
14
2
14.1
11.7
1.7
32
38
17
26.7
31.7
14.1
2=4.026
d.f=2
p=0.134
N.S
* p<0.05**, p<0.01, ***p<0.001 S - Significant NS - Not Significant
Table 6.4 shows that, there was a statistically significant association between fetal
outcome with type of delivery and iron and folic acid intake at p<0.001 level and there
was no statistically significant association between fetal outcome with other demographic
variables such as early initiation of antenatal care, vaccination, maternal weight gain and
BMI.
50
Figure 7: Percentage distribution of obstetric variables such as type of delivery and iron and folic acid intake based on fetal outcome.
0%
10%
20%
30%
40%
Normal
vaginal
delivery
Forceps
delivery
Vacuum
delivery
Cesarean
section
Regular Irregular
[CELLRANGE]
[CELLRANGE] [CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
% o
f m
oth
ers
TYPE OF DELIVERY AND IRON AND FOLIC ACID INTAKE
51
CHAPTER V
DISCUSSION
The aim of the study was to assess the relationship between maternal wellbeing
and fetal outcome among the postnatal mothers at selected hospitals in Chennai.
Totally 120 postnatal mothers were selected as samples using non-probability
convenient sampling technique. In that 60 postnatal mothers were selected from Kalyani
Multispeciality Hospital, Chennai and 60 postnatal mothers were selected from Panakjam
Memorial Hospital, Nanganallur. Demographic data and obstetrical data was obtained
from the postnatal mothers by interview method. Maternal wellbeing was assessed by
checklist using mothers response (minor disorders) and antenatal record review (high risk
conditions during pregnancy and pre-existing conditions complicating pregnancy). Fetal
outcome was assessed by checklist using biophysical measures (length, head & chest
circumference) and neonatal record review (gestational age, growth pattern, APGAR,
birth weight, congenital anomalies and reflexes). The collected data were tabulated and
analyzed using descriptive and inferential statistics and results were interpreted. The
discussion is based on the objectives specified in the study.
The significant findings of the study were as follows
In relation to demographic variables
Majority (61.6%) of the postnatal mothers were in the age group of 21-30 years, and
equal number (19.2%) of them were in age group of <21 years and 31-40 years.
Among postnatal mothers, 11.7% had no formal education and 88.3% were literate. In
that majority (30.2%) of the postnatal mothers had completed secondary education,
29.2% were completed high school education, 24.5% were completed degree, and
16.1% were completed primary school education.
52
Equal number (50%) of the postnatal mothers were unemployed and employed, in
that majority (43.3%) were employed in private, 26.7% were employed in
government job, 16.7% had own business, and 13.3% had daily wages.
Majority (61.7%) of the postnatal mothers were moderate type of worker, 25% were
sedentary worker and 13.3% were heavy worker.
Majority (40%) of the postnatal mothers had family income of Rs.10,000 to
Rs.15,000, 36.6% had family income of <Rs.10, 000, 16.7% had family income of
Rs.15,000 – Rs.20,000, and 6.7% had family income of >Rs20,000.
Majority (62.5%) of the postnatal mothers were Hindus, 27.5% of the postnatal
mothers were Christians, and 10% of the postnatal mothers were Muslims.
All the mothers were residing in the urban area.
Majority (72.5%) of the postnatal mothers were from nuclear family, 17.5% were
from joint family and 10% were from extended family.
None of the postnatal mothers had the habit of betel chewing, smoking and alcohol
consumption.
Majority (58.3%) of the postnatal mothers were multigravida, 34.2% were
primigravida mothers and 7.5% were grand multigravida mothers.
Majority (59.2%) of the postnatal mothers were primipara, 39.2% were multipara
mothers and 1.6% were grand multipara mothers.
Majority (67.5%) had one child, 29.2% had 2 children and 3.3% had >3 children.
Majority (65%) of the postnatal mothers had no history of abortion, 21.7% had one
abortion and 13.3% had >2 abortions.
Majority (51.7%) of the postnatal mothers had normal vaginal delivery, 30.8% had
cesarean section, 12.5% had vacuum delivery and 5% of them had forceps delivery.
53
All (100%) postnatal mothers had initiated antenatal care <12 weeks and were
vaccinated.
Majority, (64.2%) of the postnatal mothers had taken iron and folic acid regularly and
35.8% had irregular intake of iron and folic acid.
Majority, (70%) of the postnatal mothers had <10kg of weight gain, 21.7% had 10-
12kg of weight gain and 8.3% had >12kg of weight gain.
Majority (43.4%) of the postnatal mothers had over weight, 40.8% had normal weight
and 15.8% had obesity.
The findings of the study based on objectives were discussed
1. The first objective was to assess the maternal wellbeing and fetal outcome.
Maternal wellbeing
Majority (53.3%) of the postnatal mothers had good health, 31.7% of the
postnatal mothers had fair health and 15% of the postnatal mothers had poor health (table
3.1). So, we can infer from the findings of maternal wellbeing that majority of the
postnatal mothers were in good health even though few had poor and fair health.
The above finding is supported by the study shows that three-fourth of the mother
had good health; one-fourth had fair and poor health in maternal wellbeing (Kapil, M
2013).
Fetal outcome
Majority (72.5%) of newborn babies had risk and (27.5%) of newborn babies had
no risk (table 3.2). From the findings we can infer that majority of babies had under risk
status.
54
The above finding is supported by the study shows that there was a significant
association between neonatal congenital anomalies and lack of peri-conceptional use of
folic acid (Jehan, I. Harris, H. & Fayaz, M. (2015).
2. The second objective was to correlate the maternal wellbeing and fetal outcome
The correlation between maternal wellbeing and fetal outcome revealed that there
was a low positive correlation existing between maternal wellbeing and fetal outcome
r=0.257 at p<0.01 level of significance (table 4).
From the above finding, we can infer that the fetal outcome was influenced by the
maternal wellbeing. Good maternal wellbeing will lead to no risk status of fetal outcome.
Fair and poor maternal wellbeing will lead to risk of fetal outcome. This shows that,
when there was poor maternal health the fetal risk was increased.
Hence, the postnatal mother who had good maternal health status will have better
fetal outcome as compared to postnatal mother with fair and poor maternal health status.
The above findings were supported a study to describe the maternal weight gain
during all trimesters of pregnancy and its correlation with birth weight. The results
concluded that there is a correlation p<0.05 among total maternal weight gain in second
and third trimester with birth weight of baby (Lumbanraja S, Lutan D & Usman I, 2013).
Hence the assumption stated that earlier the antenatal registration decreased minor
and medical disorders during pregnancy better the fetal outcome was supported by study
findings.
The null hypothesis stated that there is no relationship between maternal
wellbeing and fetal outcome was rejected.
55
3. The third objective was to associate the maternal wellbeing and fetal outcome
with the demographic variables.
The study findings shows that there was a statistically significant association
between maternal wellbeing with maternal age at p<0.001 level, occupation at p<0.05
level and nature of work at p<0.01 level (table 5.1). It revealed that age, occupation and
nature of work had influenced the maternal wellbeing.
There was a statistically significant association between fetal outcome with
maternal age at p<0.001 level, occupation and family income per month at p<0.05 level
(table 5.3). It is evident that age, occupation and family income per month had influenced
the fetal outcome.
The above findings were supported to assess the maternal risk factors and
outcome of low birth weight babies admitted in tertiary care teaching hospital in Orissa.
The study concluded that among 1080 babies, 56.7% were low birth weight babies 64%
were preterm and 36% were IUGR. There was a correlation between maternal risk factors
and outcome of LBW babies (Maheswari, K & Behera, N 2014).
Hence, the assumption stated earlier that, maternal wellbeing and fetal outcome
will be influenced by the demographic variable was supported by study findings.
Hence, the null hypothesis stated earlier that there is no association between
maternal wellbeing with demographic variables like maternal age, education and
socioeconomic status and there is no association between fetal outcomes with
demographic variables like maternal age, education and socioeconomic status was
rejected.
56
4. The fourth objective was to associate the maternal wellbeing and fetal outcome
with the obstetrical variables.
There was a statistically significant association between maternal wellbeing with
gravida at p<0.01 level and abortion at p<0.001 level (table 5.5) and type of delivery, iron
and folic acid intake, maternal weight gain and BMI at p<0.001 level (table 5.6). The
findings revealed that the gravida, abortion, type of delivery, iron and folic acid intake,
maternal weight gain and BMI had influenced maternal wellbeing.
The above findings were supported by study conducted by Manisha Nair, Manoj
K Choudhury, et al. (2016) that assessed the relationship between maternal anemia and
adverse maternal and infant outcome. The results concluded that maternal iron deficiency
anemia was associated with (25%) low birth weight and (44%) small for gestational age.
There was a statistically significant association between fetal outcome with type
of delivery and iron and folic acid intake at p<0.001 level (table 5.8). It is evident that
type of delivery and iron and folic acid intake influenced the fetal outcome.
The result shows that the postnatal mothers who had good maternal health status
had positive fetal outcome. Mother with normal maternal weight gain and regular intake
of iron and folic acid supplements during pregnancy had babies with normal birth weight
and fetal development.
The above findings were supported by prospective cross sectional study
conducted to assess the prevalence and to identify risk factor affecting low birth weight
neonates in district hospital. Researcher concluded that 11.61% of postnatal mothers with
low maternal weight gain during pregnancy delivered low birth weight babies (Dandekar,
H. R & Shafee, M 2013).
Hence, the assumption stated earlier that, maternal wellbeing and fetal outcome
will be influenced by the obstetrical variables was supported by study findings.
57
Hence, the null hypothesis stated earlier that there is no association between
maternal wellbeing with obstetrical variables like gravida, para, number of live children,
abortion, type of delivery, iron and folic acid intake and maternal weight gain and there is
no association between fetal outcomes with obstetrical variables like gravida, para,
number of live children, abortion, type of delivery, iron and folic acid intake and
maternal weight gain was rejected.
58
CHAPTER VI
SUMMARY, CONCLUSION, IMPLICATION AND RECOMMENDATIONS
SUMMARY
Pregnancy and child birth is a normal physiological phenomenon. Pregnancy is a
privilege of experiencing God’s miracles on earth. The health of the mother and the
newborn are interlinked, so the newborn health and survival depends on appropriate
maintenance of maternal health and wellbeing of the mother during pregnancy. The
provisions of care of mothers before and during pregnancy were to allow the mothers to
get best possible health and to have greatest chance of giving birth to healthy baby. So
the investigator felt the need to identify the relationship between the maternal wellbeing
and fetal outcome among postnatal mother.
The objectives of the study were,
to assess the maternal wellbeing and fetal outcome.
to correlate the maternal wellbeing and fetal outcome
to associate the maternal wellbeing and fetal outcome with the demographic
variables like the age, education, occupation and socio economic status.
to associate the maternal wellbeing and fetal outcome with the obstetrical
variables like gravida, para, number of live children, abortion, type of
delivery, initiation of antenatal care, vaccination and iron and folic acid
intake.
The hypothesis of the study was,
H01- There is no relationship between maternal wellbeing and fetal outcome.
H02- There is no association between maternal wellbeing with demographic variables
like maternal age, education and socioeconomic status.
59
H03- There is no association between maternal wellbeing with obstetrical variables like
gravida, para, number of live children, abortion, type of delivery, iron and folic acid
intake and maternal weight gain.
H04- There is no association between fetal outcomes with demographic variables like
maternal age, education and socioeconomic status.
H05- There is no association between fetal outcomes with obstetrical variables like
gravida, para, number of live children, abortion, type of delivery, iron and folic acid
intake and maternal weight gain.
The assumption of the study were,
Earlier the antenatal registration better the fetal outcome.
Decreased medical disorders during pregnancy better the fetal outcome.
Decreased minor disorders during pregnancy better fetal outcome.
Review of literature provided a base to construct the tool and methodology.
Descriptive design was chosen for the study. The tool was developed and validated by
five experts, one obstetrician, one neonatologist and three obstetrics and gynecology
nursing experts. The reliability was determined by inter rater method. Feasibility was
analyzed by conducting the pilot study. The main study was conducted from 01.11.2016
to 28.11.2016 at CSI Kalyani Multispeciality Hospital, Chennai and Pankajam Memorial
Hospital, Nanganallor. Sample fulfilling the inclusion criteria were selected using non
probability convenient sampling technique. Demographic data and obstetrical data was
obtained from the postnatal mothers by interview method. Maternal wellbeing was
assessed using checklist, mothers response was obtained on minor disorders and antenatal
record review was done to assess the high risk conditions during pregnancy and pre-
existing conditions complicating pregnancy. Fetal outcome was assessed using checklist.
Length, head, chest circumference and reflexes were assessed and neonatal record review
60
was done to obtain data regarding gestational age, intrauterine growth pattern, APGAR,
birth weight and congenital anomalies. The data was analyzed using descriptive and
inferential statistics and results were interpreted.
The study findings revealed that the postnatal mothers with fair and poor health
status during pregnancy had risk in fetal outcome. There was a statistically significant
correlation between the maternal wellbeing and fetal outcome at p<0.01 level of
significance. There was a statistically significant association between maternal wellbeing
with demographic variables like maternal age, occupation and nature of work; and fetal
outcome with demographic variables like maternal age, occupation and family income
per month. Similarly there was a statistically significant association between maternal
wellbeing with obstetrical variables like gravida, abortion, type of delivery, iron and folic
acid intake, maternal weight gain and BMI; and fetal outcome like type of delivery and
iron and folic acid intake.
CONCLUSION
From the results of the study, it was concluded that fair and poor maternal health
status had increased the risk of fetal outcome. The study findings showed that maternal
wellbeing and fetal outcome is related with each other. Maternal age, occupation and
nature of work had influenced on maternal wellbeing and maternal age, occupation and
family income per month had influenced on fetal outcome. Gravida, abortion, type of
delivery, iron and folic acid intake, maternal weight gain and BMI had influenced on
maternal wellbeing and type of delivery and iron and folic acid intake had influenced the
fetal outcome. In maternal wellbeing, majority (53.3%) of the postnatal mothers had good
health, 31.7% of them belonged to fair health and 15% of postnatal mothers had poor
health. In fetal outcome, majority (72.5%) of newborn babies had risk and 27.5% had no
risk status. Good maternal health status during pregnancy leads to better fetal outcomes.
61
NURSING IMPLICATIONS
The study findings are relevant to nursing field. The implication can be discussed
mainly in the area of nursing services, nursing education, nursing administration and
nursing research.
Nursing Service
Prenatal and Antenatal counseling should be done for the pregnant mother as well
as family members which help the midwives to identify and follow the mothers
with severe minor disorders prevent complications and plan for nursing
intervention.
Health care system must do early tracking of adolescent girls for anemia and must
provide individualized surveillance programme to reduce anemia related maternal
and infant mortality rates.
Nurses must create awareness in wide range about the preexisting conditions
complicating pregnancy among antenatal mothers visiting outpatient department
to know its effect on fetus and its preventive measures.
Midwives must encourage the pregnant mother to come for early registration,
periodic antenatal visit and regular intake of iron and folic acid to improve
pregnancy and fetal outcome.
Emergency helpline services can be made available for the easy reach of health
facilities, benefits and accessible maternal health care from health care providers
to identify quality improvement in maternal care.
Midwives can improve the obstetrical care by providing outreach programme and
addressing gap in utilization of maternal health care and services.
Nurses can implement the complementary and alternative therapy in pregnant
mothers while providing care.
62
Prenatal counselling sessions can be arranged for the couple to get healthy
pregnancy.
Nursing Education
Curriculum should include about advanced technology to provide care for high
risk antenatal mother in each trimesters and its effect on pregnancy and fetal
outcome.
Seminar, conferences, panel discussion should be held to students to create
awareness regarding the care for high risk antenatal mother and preventive
measures of high risk conditions.
Students should be encouraged to study the high risk prenatal and antenatal
counseling and give health teaching make awareness among mothers.
Nurse educator can conduct staff development programme regarding
preconceptional and high risk antenatal care.
Nursing Administration
Nurse administrator should encourage and support the midwives to do clinical
trials, evidence based practices and involve them in research activities to improve
the patient care.
Nurse administrator can plan and organize in service education programme for the
staff nurses to reinforce the importance of preconceptional and antenatal care for
mothers.
Nurse administrator must extend their support to conduct community reach
programme for prevention of high risk pregnancy.
Nursing Research
Disseminate the findings of research through conferences, seminars, scientific
paper presentation and publishing in nursing journal.
63
Research study can be conducted on home care management on minor disorders
of pregnancy at rural area.
Research study can be conducted on awareness on high risk pregnancy.
RECOMMENDATIONS
Keeping the findings of the present study in view, the following recommendations
were made.
A study can be conducted with multiple variables which will influence the
maternal wellbeing and fetal outcome.
A study can be conducted in urban and rural setting and to compare the
prevalence rate of high risk mothers and their risk status.
A comparative study can be conducted to assess the primigravida and multi
gravida mothers and their fetal outcome.
A study can be conducted using variables of maternal wellbeing.
The study can include the maternal psychological effect in antepartum and
intrapartum period influence on pregnancy and fetal outcome.
An interventional study to assess the effect on alternative therapies on maternal
wellbeing and fetal outcome.
A comparative study to assess the type of delivery influence on neonatal outcome.
LIMITATIONS
There was no limitation faced by the investigator during the study.
64
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INFORMED CONSENT FORM
I have been informed about the purposes of the study being conducted by
Ms.Divya.V., M.Sc (Nursing) student of M.A.Chidambaram College of Nursing, Adyar,
Chennai and I have no objection in participating in the study. I also give my full consent
for the use of this data for the purpose of any presentation or publication.
Signature:
Name:
Date:
CERTIFICATE OF ENGLISH EDITING
This is to certify that Ms. Divya.V., II year M.Sc, (Nursing) student of
M.A.Chidambaram College of Nursing, Adyar, Chennai, conducted a dissertation work
on “To assess the relationship between maternal wellbeing and fetal outcome among
postnatal mothers at selected hospitals in Chennai”, has been edited by me for English
language appropriateness.
DATE: SIGNATURE WITH SEAL
A STUDY TO ASSESS THE RELATIONSHIP BETWEEN MATERNAL
WELLBEING AND FETAL OUTCOME AMONG POSTNATAL MOTHERS IN
SELECTED HOSPITALS, CHENNAI.
PART – I
SECTION A
DEMOGRAPHIC DATA Sample No:
1. Age in years
a) <21 years
b) 21 – 30 years
c) 31 – 40 years
d) >40years
2. Education status
a) No formal education
b) Literate
If literate,
i) Primary school
ii) High school
iii) Secondary education
iv) Degree
3. Occupation
a) Unemployed
b) Employed
If employed,
i) Government
ii) Private
iii) Business
iv) Daily wages
4. Nature of work
a) Sedentary worker
b) Moderate worker
c) Heavy worker
5. Income per month
a) < Rs.10,000
b) Rs.10,000 – Rs.15,000
c) Rs. 15,000 – Rs. 20,000
d) >Rs. 20,000
6. Religion
a) Hindu
b) Christian
c) Muslim
7. Residence
a) Urban
b) Rural
8. Type of family
a) Nuclear family
b) Joint family
c) Extended family
9. Personal habits
a) Betel chewing
b) Smoking
c) Alcohol consumption
d) None
SECTION B
OBSTETRICAL HISTORY
1. Gravida
a) Primigravida
b) Multigravida
c) Grand multigravida
2. Para
a) Primipara
b) Multipara
c) Grand multipara
3. No of live children
a) 1 child
b) 2 child
c) >3 child
4. Abortion
a) 0
b) 1
c) > 2
5. Type of delivery
a) Normal vaginal delivery
b) Forceps delivery
c) Vacuum delivery
d) Cesarean section
6. Initiation of antenatal care
a) < 12 weeks
b) > 12 weeks
7. Vaccination (Tetanus toxoid)
a) Vaccinated
b) Not vaccinated
8. Iron and folic acid intake
a) Regular
b) Irregular
9. Maternal weight gain
a) < 10kg
b) 10 – 12kg
c) >12kg
10. Height of the mother _____
11. BMI at term
a) Normal 18.5-24.9
b) Over weight 25-29.9
c) Obesity greater than 30
PART- II
TOOL TO ASSESS THE MATERNAL WELLBEING OF
MOTHER AMONG SELECTED SETTING
Note: If mark (YES) is score: 1 and mark (NO) is score: 0
S.NO. ITEMS SCORE 1
Trimester
2
Trimester
3
Trimester
MAXIMUM
SCORE
MINOR DISORDERS
DURING
PREGNANCY
1. Nausea 1 3
2. Vomiting 1 3
3. Leukorrhea 1 3
HIGH RISK IN
PREGNANCY
4. Bleeding 1 3
5. Infection 1 3
6. Anemia 0 0
a) Mild (9-10gram % of
hemoglobin)
1 3
b) Moderate (7-9gram %
of hemoglobin) 1 3
c) Severe (<7gram % of
hemoglobin)
1 3
7. Pregnancy induced
hypertension (PIH)
0 0
a)Controlled (Blood
pressure <140/90
mmhg without
proteinuria)
1 2
b)Uncontrolled (Blood
pressure >140/90 mmhg
with proteinuria)
1 2
8. Eclampsia 0 0
a)Controlled 1 2
b)Uncontrolled 1 2
Gestational diabetes
mellitus (GDM)
0 0
a)Controlled (Fasting
plasma glucose <90mg
and postprandial
<120mg )
1 2
S.NO. ITEMS SCORE 1
Trimester
2
Trimester
3
Trimester
MAXIMUM
SCORE
b)Uncontrolled (Fasting
plasma glucose >90mg
and postprandial
>120mg)
1 2
EXISTING
CONDITION
COMPLICATING
PREGNANCY
10 Fever 1 3
11 Hypertension
a) Controlled 0 0
b) Uncontrolled 1 3
12 Diabetes mellitus
a) Controlled 0 0
b) Uncontrolled 1 3
13 Thyroid dysfunction
a) Controlled 0 0
b) Uncontrolled 1 3
14 Cardiac diseases 1 3
15 Abdominal surgeries 1 3
SCORING AND INTERPRETATION
The maximum score is 54 and total score were arbitrarily classified as
Scores Interpretation
>75% Good health
50-75% Fair health
<50% Poor health
PART- III
TOOL TO ASSESS THE FETAL OUTCOME IN SELECTED SETTINGS
Note: If mark (YES) is score: 0 and mark (NO) is score: 1
Age: Gender:
S.NO. ITEMS SCORE YES / NO MAXIMUM
SCORE
1. Gestation age 1
a) Preterm 1
b) Term 0
c) Post term 1
2. Growth pattern 1
a) IUGR (Intrauterine growth
restriction)
1
b) Appropriate to gestational age 0
c) Large for gestation 1
3. APGAR score at 1 minute 1
a) 1-3 1
b) 4-6 1
c) 7-10 0
4. APGAR score at 5 minutes 1
a) 1-3 1
b) 4-6 1
c) 7-10 0
5. Birth weight 1
a) <2,500 grams 1
b) 2,500-4,000 grams 0
c) >4,000 grams 1
6. Length 1
a) < 50cm 1
b) 50-52 cm 0
c) > 52 cm 1
7. Head circumference 1
a) <32 cm 1
S.NO. ITEMS SCORE YES / NO MAXIMUM
SCORE
b) 32-37 cm 0
c) >37 cm 1
8. Chest circumference 1
a) <30 cm 1
b) 30-35 cm 0
c) >35 cm 1
9. Congenital anomalies 1
a) Present 1
b) Absent 0
10. Reflexes 0 16
REFLEXES
Note: If mark (YES) is score: 0 and mark (NO) is score: 1
S.NO. REFLEXES ELICITED NOT-ELICITED
1. REFLEXES OF EYE
i) Blinking
ii) Doll’s eye
2. REFLEXES OF NOSE
i) Sneeze
ii) Glabellar
3. REFLEXES OF MOUTH
i) Rooting
ii) Sucking
iii) Gag
iv) Extrusion
v) Cough
4. REFLEXES OF
EXTRIMITIES
i) Grasp
ii) Babinski
5. MASS REFLEXES
i) Moro reflex
ii) Tonic neck reflex
iii) Galant reflex
iv) Dance or stepping reflex
v) Crawl
SCORING AND INTERPRETATION
The maximum score is 25 and total score were arbitrarily classified as
Scores Interpretation
<50% No risk
>50% Risk